All you need to know about preventive chemotherapy

After a torrent of memes and obsessive discussions around the ‘disappearance’ of Kate Middleton, speculations came to a rest in late March. In a video released by the Kensington Palace, the Princess of Wales announced the reason for her prolonged absence. “In January, I underwent major abdominal surgery in London and at the time, it was thought that my condition was non-cancerous,” the Princess of Wales said in the video, as reported by Time magazine. 

Also read: Understanding cancer and its treatments in the wake of Britain’s royal family news

“The surgery was successful. However, tests after the operation found cancer had been present.” “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she had said. Ever since, the term ‘preventative chemotherapy’ has entered mainstream lexicon, making everyone curious about what it entails. 

Technically referred to as ‘adjuvant therapy’, preventative/preventive chemotherapy is a crucial strategy to thwart the recurrence of cancer. In a country like India that has recently earned itself the title of the ‘Cancer capital of the world’, courtesy Apollo Hospitals’ Health of the Nation Report 2024, understanding the significance of preventative chemotherapy gathers greater relevance. 

Treatment cycle
“Adjuvant chemotherapy is administered after the primary therapy — often surgery— to target and eradicate any remaining cancer cells that may have spread beyond the initial tumour site,” says Dr Narender Kumar Thota, HOD and consultant hemato oncologist and stem cell/bone marrow transplant (BMT) specialist at KIMS Hospitals, Secunderabad. The purpose of the treatment is to significantly reduce the risk of cancer recurrence or metastasis.

The decision to go for adjuvant chemotherapy is determined by doctors based on multiple factors. These include cancer type and stage, the presence of (molecular or biochemical) biomarkers in the body, the extent of tumour removal, and the patient’s overall health.  “Drug selection in this treatment is tailored to each patient’s specific situation. It involves utilising chemotherapy agents with proven efficacy against the cancer type being treated,” Kumar explains. 

Adjuvant chemotherapy is administered in cycles, with each cycle comprising treatment — the medicines can be administered intravenously or as tablets — followed by a rest period to allow for recovery. Though effective, Kumar takes care to mention that chemotherapy drugs can lead to side effects due to their effect on both cancerous and healthy cells. Issues such as fatigue, nausea, hair loss, and susceptibility to infections are common. Monitoring and follow-up are crucial throughout treatment and post-treatment phases. This involves regular assessments for treatment response, side effect management, and surveillance for cancer recurrence. Through careful consideration and monitoring, adjuvant chemotherapy aims to improve long-term outcomes and quality of life for cancer patients.  

Mumbai-based Renuka Rathore, 35, a breast cancer survivor, vividly recalls her experience with adjuvant chemotherapy. “Initially, I was apprehensive about undergoing more treatment,” she shares. “But knowing it could prevent cancer from coming back gave me the strength to endure.” 

Also read: How AI can reshape cancer care in India

A multifaceted approach
Adjuvant chemotherapy does not have a one-size-fits all solution. The word ‘chemoprevention’ can be used in different contexts, says Dr Anusheel Munshi, head of radiation oncology, Manipal Hospital, New Delhi. It can mean the use of certain agents to prevent the onset of certain cancers. For example, there have been studies that used medications such as tamoxifen to prevent breast cancer in higher risk patients.

Similarly, studies have explored the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing colorectal cancer risk. Some vitamins like vitamin C and D have also been tried to help prevent cancer. However, not many of these agents that have been tested have become a standard of care, Munshi notes. This is primarily because of the possible side effects of long term use of these agents. 

What has become more established as a prevention strategy is focussing on avoiding established risk factors like habits (smoking, alcohol) and lifestyle (junk food, obesity, sedentary style),” he adds to underline the importance of adopting a preventive lifestyle to pre-empt the disease. In addition, early reporting of symptoms and cancer screening tests for certain types has been known to improve outcomes. Different cancers require different treatment approaches and systemic therapy/chemotherapy agents. 

Since present-day cancer management requires multidisciplinary care, it is always encouraged that treating hospitals have multidisciplinary tumour boards staffed with experts from relevant specialities to decide comprehensive treatment plans for patients. 

Psychological & emotional toll
The physical side effects of chemotherapy can exacerbate feelings of depression, sadness, and hopelessness. For Rathore, for instance, the treatment was physically taxing, marked by bouts of nausea, fatigue, and hair loss. Adjuvant chemotherapy left Nandita Gill, 30, a Delhi-based homemaker with an unwelcome companion — weight gain. It felt like an added punishment as the pounds piled on, she says. 

Each day was a reminder of the physical toll chemotherapy took on my body, leaving me feeling trapped in a cycle of discomfort and frustration. Despite my efforts, shedding the weight seemed like an impossible task, casting a shadow over my recovery journey,” Gill recalls. 

“Body image concerns resulting from chemotherapy-induced physical changes, such as hair loss and weight fluctuations, can significantly impact self-esteem,” says Dr Neerja Agarwal, psychologist and co-founder of Emoneeds in Gurugram. Counselling and support aimed at promoting self-acceptance beyond physical appearance are crucial in fostering resilience and improving overall well-being, she observes.

Coping with cancer treatment also presents challenges like strained relationships and financial stress. It’s also important to acknowledge the intense fear and anxiety that often accompanies a cancer diagnosis, compounded by uncertainties about the treatment’s effectiveness and potential outcomes. “Providing tailored emotional support, including relaxation techniques, mindfulness practices, and cognitive-behavioural therapy (CBT), can help individuals manage these feelings and build resilience,” Agarwal adds.

Delhi resident Rakesh Kumar, 47, a colon cancer patient underwent the treatment because “the fear of cancer returning loomed large.” “Preventive chemotherapy felt like a necessary step in safeguarding my future,” he reflects. Despite grappling with side effects such as neuropathy and gastrointestinal discomfort, Kumar remains resolute in his commitment to the treatment, finding solace in the prospect of long-term remission. 

Also read: 8 dietary basics to cancer-proof your body